Basic Information
| Provider Information | |||||||||
| NPI: | 1114507373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGETT | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | SEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2460 NEWBERRY ST | ||||||||
| Address2: | |||||||||
| City: | ROSAMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935606736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613610026 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44447 10TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935343324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189961051 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2021 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.